Pancreas Transplantation Committee Fall 2014 Hi, my name is __________________ and I am going to provide an update on the Pancreas Committee.

Policy Implementation Dates Changes to the pancreas allocation system Combines pancreas and kidney-pancreas (KP) on same match run Creates qualifying criteria for kidney-pancreas candidates to begin to accrue waiting time Implementation date: October 30, 2014 There were major changes to the pancreas allocation system that were implemented on October 30, 2014. As a reminder, the changes to the pancreas allocation system are combining pancreas and kidney-pancreas candidates on the same match run and creating qualifying criteria for kidney-pancreas candidates to begin to accrue waiting time.

Qualifying Criteria for KP Candidates Who Register After Implementation Candidate registered for a KP Candidate must qualify for kidney waiting time according to Policy 8.4 Waiting Time Candidate meets at least one of the following criteria: on insulin and c-peptide is less than or equal to 2 ng/mL on insulin and c-peptide is greater than 2 ng/mL and BMI is less than or equal to 28 Based on the changes to the pancreas allocation system, newly registered KP candidates will have to meet and enter qualifying criteria to begin accruing KP wait time. The qualifying criteria for KP candidates to begin accruing KP wait time are: The KP candidate must be registered for a KP The KP candidate must qualify for kidney waiting time according to Policy 8.4 Waiting Time The KP candidate must meet at least one of the following criteria: Is on insulin and has a c-peptide less than or equal to 2 ng/mL, OR Is on insulin and has a c-peptide that is greater than 2 ng/mL and BMI is less than or equal to 28

Waiting Time for Existing KP Candidates KP candidates that have accrued KP waiting time before implementation Will retain KP waiting time Will continue to accrue KP waiting time Do not have to meet qualifying criteria #3 KP candidates who are registered for a KP before the changes to the pancreas allocation system were implemented (on October 30, 2014), and have met qualifying criteria to accrue kidney waiting time, will retain their KP waiting time, will continue to accrue KP waiting time, and do not have to meet qualifying criteria #3.

Ongoing Committee Initiatives Pancreas Underutilization project Updates to policy and process: Facilitated Pancreas Allocation Would you support creating qualifying criteria for participating transplant programs? Would you support creating a routine monitoring process for participating transplant programs? Investigation: High pancreas discards The Committee continues to work on it’s Pancreas Underutilization project. This project includes policy language changes to the Facilitated Pancreas Allocation policy and investigating reasons for high pancreas discards. Facilitated Pancreas Allocation As a reminder, Facilitated Pancreas Allocation is an additional pancreas placement method that takes effect after a certain period of time where the pancreas has not been placed. Currently, transplant programs may elect to be a part of this additional pancreas placement method and the Organ Center works with the transplant programs that are a part of the Facilitated Pancreas Allocation in order to make the placement happen. The Committee is discussing creating qualifying criteria where transplant programs that want to participate in Facilitated Pancreas Allocation will have to meet the qualifying criteria before the transplant program may participate. The Committee is also considering creating a routine monitoring process to assess whether participating transplant programs are correctly utilizing the Facilitated Pancreas Allocation process. The details of this monitoring process are not available yet, however, the monitoring process may consist of a report that the Committee annually reviews to ensure participating transplant programs are not abusing the Facilitated Pancreas Allocation process. Would you support creating qualifying criteria and a routine monitoring process for transplant programs participating in the Facilitated Pancreas Allocation process? Look for a public comment with these policy changes in early 2015 or summer 2015. Reasons for High Pancreas Discards The Committee is in the midst of investigating the reasons for high pancreas discards.

Questions? Jonathan Fridell MD Committee Chair jfridell@iupui.edu Regional representative name (RA will complete) Region X Representative email address Kristina Tyler JD Committee Liaison Kristina.Tyler@unos.org